CHAPTER 11 | Etiology of Poor Oral Health 169


chewing (typically done with posterior teeth) are both compromised.


• Masticatory or chewing ability: Older adults should be asked about their ability to bite, chew, and swallow and should be observed at a meal period for pocketing of food in the mouth or cheek before swallowing. Ask older adults about any alterations in diet as a result of their mouth condition, including foods avoided or need- ing texture adjustments (eg, finely cut, ground, minced, or pureed). Ask about the presence of any pain, mouth ulcers (current and historical) in the oral cavity, pain frequency, and what relieves or exacerbates pain.


• Presence of removable partial or full den- tures: Older adults should be asked if they use dentures for eating. Dentures are expensive and not replaced routinely. When assessing denture adequacy, consider the appearance, fit, and func- tionality. Dentures may make a clicking noise, which may increase the self-consciousness of older adults when eating in public. When assessing indi- viduals with dentures, it is always best to observe them eating. To better understand functional ability, watch specifically as they move their jaw up and down. Assess denture stability by observ- ing if the dentures stay in place or move around. After observing older adults eating, check for food collected or pocketed in the buccal folds of the mouth. During the interview, ask older adults the following questions, and refer older adults with any atypical responses to a dental professional:


− Do you eat with your dentures? If not, why? − What type of adaptations do you make? − Do you have any difficulty biting, chewing, or swallowing with your dentures? Without your dentures?


− When was the last time you had your denture fit checked? Do they fit properly?


• Saliva adequacy: Saliva should be copious, clear, and thin. However, when a salivary disorder is present, older adults may complain of muco- sal dryness. Changes in saliva—too little or too much—can be visibly observed during the oral portion of the NFPE. Changes in salivary pro- duction should be investigated to determine any


correlation with changes in medications or new disease onset. Saliva quality and quantity can be affected by infections, viruses (eg, Epstein-Barr virus), chronic diseases (eg, cancer) or their treat- ments (eg, radiation, which can cause saliva to become thick and ropey), or autoimmune con- ditions (eg, Sjögren syndrome). Xerostomia can also be a side effect of inadequate fluid intake, dehydration, or use of medications.55


Symptoms


of salivary gland dysfunction include swelling, dry mouth, pain, fever, blunted taste, and foul-tasting drainage into the mouth. Salivary gland dysfunc- tion can result in chewing and swallowing diffi- culties, altered taste, and increased risk of mucosal diseases and caries.55


may also be observed. Individuals with any indi- cation of salivary difficulties should be referred to a dentist or primary care practitioner for further evaluation. Saliva adequacy can be determined through examination of the oral cavity, specifically the salivary glands, coupled with simple subjec- tive questions such as:


− Does your mouth feel dry? If so, when? − Can you eat a meal without a drink? − Describe any salivary changes, when they began, and when they typically occur.


• Soft tissue components of the mouth: Exam- ine the tongue, palate, gums, and oral mucosa for any abnormal coloration, lesions, or alterations in appearance. Normal mucosa is pink and moist without lesions or infection. Abnormal findings can identify existing and potential nutritional and systemic problems. Lesions, infections, and ulcer- ations can be painful and affect eating ability and nutrient intake. In addition to nutrition-related interventions to ensure adequate intake, non– nutrition-related interventions may be required to correct the actual problem and restore oral tissue integrity. In addition, examination of the oral soft tissue can identify oral manifestations of nutrient deficiencies and systemic disease. Anemias (iron, folate, and vitamin B12 deficiencies) may pres- ent with mucositis, aphthous ulcer, sore burning mouth, halitosis, and taste changes.56,63


The rela-


tionship between osteoporosis and tooth loss has been well documented. Osteoporosis is known


Drooling or angular cheilitis


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